Annals for Educators - November 2023
Authors: Christine Laine
Journal: Annals of Internal Medicine (2023)

Web ExclusivesNovember 2023Annals for Educators - November 2023FREEChristine Laine, MD, MPHChristine Laine, MD, MPHSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/AWED202311210 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Clinical Practice PointsRelationship Between Clinician Language and the Success of Behavioral Weight Loss Interventions. A Mixed-Methods Cohort StudyConversations About Obesity and Weight: Good News We Can UseLittle is known about how clinicians can discuss weight and weight treatment in ways that are well received and effective. This study analyzed recordings of physicians' conversations with their patients about a 12-week behavioral weight loss intervention and examined the relationship between linguistic and paralinguistic features and patients' subsequent attendance in the program and their weight loss outcomes. The accompanying editorial discusses the findings and notes that with the arrival of increasingly promising behavioral, pharmacotherapeutic, and surgical treatments for obesity, there is much to be optimistic about.Use this article and the editorial to:Discuss why “mixed-methods study” is an appropriate description of the study reported in this article.Review the recommendations for diagnosis and counseling of patients with obesity. This In the Clinic review can help guide the discussion. Role-play a discussion about weight loss interventions between a physician and a patient with obesity.Inappropriate Prescribing to Older Patients by Nurse Practitioners and Primary Care PhysiciansBeyond Titles: The Need to Reduce Prescribing Variation of Potentially Inappropriate Medications Among All CliniciansMany states have enacted laws to increase the autonomy of nonphysician providers. Professional medical organizations have opposed these laws by raising concerns about adverse effects on the quality of care. Previously published studies were relatively small and were unable to confirm these concerns. This larger study compared the prescribing patterns of physicians and nurse practitioners in the 29 states where nurse practitioners had the authority to prescribe during 2013 to 2019. The accompanying editorial discusses the findings and the need for all clinicians to improve prescribing behaviors.Use this article and the editorial to:Review the laws regarding the scope of practice for nurse practitioners in the region where your health system operates.Ask your learners to list the pros and cons of enabling nurse practitioners to prescribe medications without physician supervision.Poll your learners about whether they expected or were surprised by the findings of this study.Discuss strategies that could improve the appropriateness of prescribing for all clinicians.Effect of Complementary Interventions to Redesign Care on Teamwork and Quality for Hospitalized Medical Patients. A Pragmatic Controlled TrialTeamwork is essential for delivering safe and effective care, especially in hospital settings. Such strategies as localizing physicians to specific units while on service, implementing nurse–physician unit co-leadership, and conducting interprofessional rounds seem to promote collaboration among health care professionals. However, it remains unclear whether these interventions can ultimately lead to improved patient outcomes, particularly if they are applied simultaneously. This study aimed to examine the effect of 5 complementary interventions on interprofessional teamwork climate and patient outcomes.Use this article to:Discuss the features that distinguish pragmatic and traditional randomized controlled trials. Why did these researchers identify their study as a pragmatic trial?Discuss whether any of the teamwork interventions implemented in this study are in effect at your institution.Discuss possible explanations for why the interventions studied here fell short of improving patient outcomes.Ask your learners whether they think these strategies should be implemented even if they do not lead to measurable improvement in patient outcomes.Effects of Remote Patient Monitoring Use on Care Outcomes Among Medicare Patients With Hypertension. An Observational StudyRemote patient monitoring is being used with increasing frequency for chronic conditions, particularly hypertension. This study used Medicare data to emulate a cluster randomized trial on the use of remote patient monitoring for hypertension care at the practice level, with a focus on hypertension medication use, outpatient visit use, testing and imaging use, hypertension-related acute care use, and total hypertension-related spending.Use this article to:Invite a hypertension specialist to your session to review the remote monitoring mechanisms available to patients at your institution.Discuss the limitations of the study's approach, which involved examining remote monitoring at the practice level rather than the patient level.Ask your learners to identify confounding practice-level features that might have contributed to the differences in the observed outcomes and may not be attributable to remote monitoring.Once-Weekly Insulin Icodec With Dosing Guide App Versus Once-Daily Basal Insulin Analogues in Insulin-Naive Type 2 Diabetes (ONWARDS 5). A Randomized TrialOnce-weekly insulin icodec, a basal insulin analogue that is currently in development, is intended to reduce treatment burden in patients with type 2 diabetes. This randomized trial sought to compare the effectiveness and safety of icodec titrated with a dosing guide app versus once-daily basal insulin analogues dosed per standard practice.Use this article to:Invite a pharmacist to your session to give an overview of the various types of insulin that are currently available.Discuss the degree to which the dosing app likely contributed to the observed outcomes.Discuss whether once-weekly icodec, when it becomes available, might improve patients' willingness to start insulin when type 2 diabetes control is suboptimal.Effectiveness of Nirmatrelvir–Ritonavir Against the Development of Post–COVID-19 Conditions Among U.S. Veterans. A Target Trial EmulationLimited information is available on the effectiveness of oral antivirals used to treat acute COVID-19 in preventing the development of post–COVID-19 conditions (PCCs) after acute infection. This retrospective target trial emulation study sought to measure the effectiveness of outpatient treatment of COVID-19 with nirmatrelvir–ritonavir in preventing PCCs.Use this article to:Review the methods of target trial emulation. How do target trial emulations improve on other observational study designs? This article may help guide the discussion. Ask your learners about patients they have encountered who have persistent symptoms after acute COVID-19. What symptoms are most common among such patients?Review the CDC's definitions of PCCs. Ask your learners whether, based on the findings of this study, they would prescribe nirmatrelvir-ritonavir to patients with COVID-19 who are not at high risk for severe disease with the goal of reducing risk for PCCs.What Internal Medicine Physicians Need to Know About ContraceptionThis article summarizes the ACP/Annals Forum held on 13 September 2023 that featured expert panelists discussing what internal medicine physicians need to know about contraception.Use this article and the video to:Watch the program as a group.Ask your learners whether they routinely address contraception with women of childbearing potential. If not, why not?Invite a gynecologist to your session to show your learners contraceptive implants and various types of intrauterine devices.Arrange training sessions for your residents and faculty so that they are certified to insert and remove contraceptive implants and intrauterine devices.Invite a pharmacist to your session to review the various types of oral contraceptives that are available at your institution.ProfessionalismPersonal Actions to Create a Culture of Inclusion: Navigating Difficult Conversations With Medical ColleaguesMicroaggressions between medical team members may require difficult conversations to restore inclusivity, diversity, and a healthy work culture. This article outlines important considerations to assist with intentional preparation and modulation of responses for the initiator of the conversation, observers of the incident, and the receiver of the conversation.Use this article to:Ask your learners to share examples of difficult conversations they have had with colleagues. If they are reluctant, share some examples of your own.Review the definition of “microaggression.”Role-play difficult conversations using the strategies suggested in this article.Do you like reading Annals for Educators? Receive it direct to your inbox. Sign up for the Annals for Educators alert today. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Christine Laine, MD, MPHFrom the Editors of Annals of Internal Medicine and Education Guest Editor, Gretchen Diemer, MD, MACP, Associate Dean of Graduate Medical Education and Affiliations, Thomas Jefferson University. 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